After the Pennsylvania Health Department announced Wednesday that one of the two people whose deaths in the state were associated with measles was an infant, the coroner involved in the case has said he does not consider measles to be the cause of death.The Lancaster County coroner, Dr. Stephen Diamantoni, said in an interview Wednesday evening that the baby died shortly after birth from an internal hemorrhage and “traumatic rupture” of the spleen. He said he found evidence of the measles virus in the infant’s lung tissue. It is still unclear whether measles played a role in the infant’s death. An infection can cause the spleen to enlarge — which raises the risk of rupture — but that could be difficult to detect in an autopsy after a rupture has occurred. Diamantoni, a Republican who has held the elected position since 2008, said he did not find evidence that the infant’s spleen was enlarged.He added that he was investigating the death further, saying the infant was born at a birthing center assisted by a lay midwife who was not certified in midwifery.The health secretary, Dr. Debra Bogen, expressed confidence Wednesday in her department’s conclusion that the death was “measles-associated,” a term that means there was laboratory or epidemiologic evidence of a measles infection.“As a pediatrician with more than 30 years of caring for children, I have thoroughly reviewed the case investigation information and sadly can confirm that there were two recent measles-associated deaths in Lancaster County,” Bogen said in a statement. Gov. Josh Shapiro, a Democrat, nominated her for the role in 2023.The Health Department has not provided details about the second death linked to measles, though it said Tuesday that both people were unvaccinated. Newborns are not eligible for the measles, mumps and rubella (MMR) vaccine; the first dose is recommended at 12 to 15 months and the second at 4 to 6 years.In Lancaster County, the share of kids who have gotten the MMR vaccine fell from 95.5% in 2017 to 87.6% last year. Generally, a threshold of 95% is considered necessary to maintain herd immunity.The two deaths are the first associated with measles in the U.S. this year and the first in Pennsylvania in 35 years.The state’s Health Department has confirmed 424 measles cases this year, 94 of which were diagnosed in the past week. So far, 73 people have been hospitalized for measles complications in Pennsylvania.Nationwide, 2,777 measles cases have been confirmed this year, the most in 35 years.Dr. Paul Offit, a pediatrician and director of the Vaccine Education Center at Children’s Hospital of Philadelphia, said two deaths out of 494 reported cases is a stunning number, given that, historically, measles infections cause 1 to 2 deaths per 1,000 cases. “That’s 1 death per 200 people,” Offit said, suggesting the scope of the outbreak may be more dire than official numbers show. “This is much worse than people are saying.”